“I am overweight Doc, can I develop asthma?”

A question I hear almost everyday, the answer still surprises me to this day.

Asthma (az-muh, as-) is a chronic disease that affects millions of people worldwide. Its primary cause is inflamed airways in the lungs. This inflammation makes the airways smaller, which makes it more difficult for air to move in and out of the lungs. Asthma is the most common serious disease among children and a growing problem in adults.

Symptoms that you might have asthma include coughing, shortness of breath, and chest tightness. Signs often seen on physical exam are wheezing and rapid respirations. In younger patients they will complain that their “chest hurts” or that they can not “catch their breath.” Colds may “go straight to their chest.” They may also cough when sick, particularly at night.

Many people have “allergic asthma,” which means that allergens—like dust mites, mold, animal dander, pollen and cockroaches—make their symptoms worse. In children however, the two most common triggers
of asthma are colds as well as allergens.

Other common questions I often hear on asthma… Can my asthma be outgrown? Many babies who wheeze, sick with viral respiratory infections will stop wheezing as they grow older. If the child has atopic dermatitis (eczema) or skin asthma, allergies or if there is smoking in the home or a strong family history of allergies or asthma, there is a greater chance that asthma symptoms will persist.

Can asthma be cured? Not yet. However, for most children and adults, asthma can be controlled throughout life with appropriate diagnosis, education, and treatment.

Can asthmatics exercise? Once asthma is controlled, (usually with the help of proper medications), exercise should in fact become part of ones’ daily activities. Children and adults with asthma certainly can and do excel in athletics. Many Olympic athletes have asthma.

Moreover, other things that can affect adult asthma include:

• Pregnancy: Uncontrolled asthma can harm the health of a mother and her baby.
• Work situations: Fumes, gases, or dust that are inhaled at work can trigger asthma.
• Age: Older people with asthma face unique health challenges and may not readily respond to medications.
• Exercise: Some people may have asthma symptoms when they exercise.
• Medications: Medications like aspirin and ibuprofen, or beta-blockers (used to treat heart disease, high blood pressure, migraine headaches, or glaucoma), may cause an asthma attack in some adults.
• Obesity: Obesity can affect lung growth, resulting in smaller lungs. This effect can cause permanent changes in airway function.

Obesity and asthma
Now here lays the dilemma: does obesity cause asthma or does asthma cause obesity? Or are they just two very common medical conditions that happen to coexist? And how does diabetes fit into the obese asthmatic patient?

Most have assumed that asthma comes first, limiting activity, making it difficult to exercise, leading to obesity. Some, however, have put forward that the obesity came first. Because of the extra fat, obesity makes it harder to breathe with the respiratory muscles having to work harder to move air in and out. The chest wall does not move as easily as it should and this can cause shortness of breath and ultimately wheezing. There is evidence that supports both, surprisingly. In fact, if one is obese and has asthma, one is more likely to have severe asthma requiring multiple medications.

Link with diabetes
Now how does diabetes fit into all these? The association between obesity and type 2 diabetes may be causally linked through the growth and development of adipocytes or fat cells. It is suggested that the over-consumption of high-fat, high-sugar foods and drinks, the ones we overwhelmingly love to eat, leads to the growth of adipocytes—the cells that compose adipose tissue that is specialized in storing energy as fat. As these cells increase in size, they develop localized hypoxia (oxygen deprivation) and release chemicals as inflammatory mediators, including reactive oxygen and nitrogen intermediates, which increase insensitivity to insulin. This ultimately leads to an increase in free fatty acids and blood glucose. Confused?

The fat becomes furious? Yes, to an extent because the fat cells apparently raise blood glucose and makes it harder to breathe, well, to an extent.

So being fat increases the chances to develop diabetes? Yes again. How about being fat helps in the development of asthma? Yes, still.

Some research suggests that obesity may trigger asthma through hormones as well. Women are 7 percent more likely to have asthma than men. There may be more than just sex hormones at play. Leptin is a hormone produced by fat tissue that regulates eating behavior. Researchers in Japan have found higher levels of leptin in children with allergies, asthma, and obesity. Leptin found consistently in these patients may hold the key in their relationships.

It wouldn’t be surprising at all to find out that both diet- and surgically induced weight loss could improve the severity and symptoms of asthma as well as type 2 diabetes. In overweight =or obese people with asthma, weight loss significantly reduces asthma symptoms and the need for medication, and improves airflow.

Not to mention, it is easier to exercise if one isn’t overweight.

There has been a remarkable increase in the rate of asthma, obesity, and type 2 diabetes over recent decades. Evidence suggests that these conditions may be related either through anatomical, inflammatory, or combined mechanisms. Whatever the mechanism, the presence of diabetes and asthma in people who are obese increases healthcare costs and usage, and this complicates treatment. Healthcare providers should recognize that these conditions when present together may act synergistically. Therefore, the focus of treatment should be with obesity as a common denominator to improve both diabetes and asthma.

Treatment
Losing weight is always easier p, said than done. Obesity is on the rise worldwide, with as many as 130 percent of adults and 15 percent of children considered obese and millions more being overweight. This may be complicated if the regimen used for weight loss includes exercise, which usually does. This may be further complicated if the patient has asthma.

For an asthmatic, losing weight carries more trials. With asthma attacks, you won’t be able to exercise. But even when asthma is under control, you may feel short of breath minutes into a workout. That’s because the excess weight you carry compresses your lungs, limiting how much air you can breathe in and narrowing your airways.

Furthermore, it has been determined that to effect an improvement in one’s health through weight loss in an obese patient with asthma, the asthma needs to be controlled first, and controlled well. Exercise remains an important part of any weight-loss program, but if asthma is not well-controlled, it is impossible to work out to your full potential. If you are obese, then not only can proper asthma management help you with weight control but weight loss can in turn improve your asthma.

For a type 2 diabetic, losing weight and being active plays a large part in preventing diabetes and its complications. This will never be achieved if a patient with type 2 diabetes has uncontrolled asthma. Proven asthma treatments, including avoidance of environmental triggers and proper use of medications, work best in achieving asthma symptom control. Exercise would usually be advised once this is achieved, and in the diabetic and asthmatic patient, could mean the short road to recovery.

So all I have to do, Doc, is to lose weight and my asthma and type 2 diabetes can improve?

A question I don’t usually hear too often, and the answer shouldn’t really surprise anyone—of course!

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